Performance of Antibodies against Tissue Transglutaminase for the Diagnosis of Celiac Disease: Meta-Analysis

Ζιντζαράς, Ηλίας; Germenis, Anastasios E.

doi:10.1128/cvi.13.2.187-192.2006

Cited by 51 publications

(22 citation statements)

References 41 publications

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“…In the literature, sensitivity rates vary between 0.85-0.98, depending of the prevalence of CD in the respective cohorts and the study design [12,27,29,31]. In a recent systematic review, Rostom et al [24] calculated pooled sensitivity rates for IgA-tTG and IgA-EMA of 0.90.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children

et al. 2008

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There has been growing recognition of a changing clinical presentation of celiac disease (CD), with the manifestation of milder symptoms. Serologic testing is widely used to screen patients with suspected CD and populations at risk. The aim of this retrospective analysis was to evaluate the clinical presentation of CD in childhood, assess the diagnostic value of serologic tests, and investigate the impact of IgA deficiency on diagnostic accuracy. We evaluated 206 consecutive children with suspected CD on the basis of clinical symptoms and positive serology results. Ninety-four (46%) had biopsy-proven CD. The median age at diagnosis of CD was 6.8 years; 15% of the children were <2 years of age. There was a higher incidence of CD in girls (p=0.003). Iron deficiency and intestinal complaints were more frequent in children with CD than those without CD (61% vs. 33%, p=0.0001 and 71% vs. 55%, p=0.02, respectively), while failure to thrive was less common (35% vs. 53%, p=0.02). The sensitivity of IgA tissue transglutaminase (IgA-tTG) was 0.98 when including all children and 1.00 after excluding children with selective IgA deficiency. The specificity of IgA-tTG was 0.73 using the recommended cut-off value of 20 IU, and this improved to 0.94 when using a higher cut-off value of 100 IU. All children with CD and relative IgA deficiency (IgA levels that are measurable but below the age reference [n=8]) had elevated IgA-tTG. In conclusion, CD is frequently diagnosed in school-age children with relatively mild symptoms. The absence of intestinal symptoms does not preclude the diagnosis of CD; many children with CD do not report intestinal symptoms. While the sensitivity of IgA-tTG is excellent, its specificity is insufficient for the diagnostic confirmation of a disease requiring life-long dietary restrictions. Children with negative IgA-tTG and decreased but measurable IgA values are unlikely to have CD.

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Section: Discussionmentioning

confidence: 99%

Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children

et al. 2008

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“…The discriminating quality of each biological marker was evaluated independently using receiver operating characteristic (ROC) curve analysis [3]. The ROC curve analysis was applied for two comparisons: PPE against TPE and MPE, and TPE against MPE and PPE.…”

Section: Statistical Methodologymentioning

confidence: 99%

Discrimination of exudative pleural effusions based on multiple biological parameters

Daniil

Ζιντζαράς²,

Kiropoulos³

et al. 2007

Eur Respir J

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Pleural effusion is a common complication of various diseases. Conventional methods are not always capable of establishing the cause of pleural effusion, so alternative tests are needed. The aim of this study was to explore means of discriminating between different pleural effusion groups, malignant, parapneumonic and tuberculous, based on the combined function of seven biological markers.Adenosine deaminase (ADA), interferon-c, C-reactive protein (CRP), carcinoembryonic antigen, interleukin-6, tumour necrosis factor-a and vascular endothelial growth factor concentration levels were measured in pleural fluid from 45 patients with malignant, 15 with parapneumonic and 12 with tuberculous pleural effusion. Receiver operating characteristic curve analysis, multinomial logit modelling and canonical variate analysis were applied to discriminate the pleural effusion groups.The three groups could be discriminated successfully using the measured markers. The most important parameters for discrimination were ADA and CRP concentration levels. An individual with an ADA concentration level of .45 U?L -1 and a CRP concentration of ,4 mg?dL -1 was more likely to belong to the tuberculous pleural effusion group, whereas one with an ADA concentration level of ,40 U?L -1 and a CRP concentration of .6 mg?dL -1 was more likely to belong to the parapneumonic pleural effusion group, and one with a CRP concentration of ,4 mg?dL -1 to the malignant pleural effusion group. The combination of adenosine deaminase and C-reactive protein levels might be sufficient for discriminating between the three different groups of exudative pleural effusion: malignant, tuberculous and parapneumonic.

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“…In children who were diagnosed with CD, the average number of samples studied, with standard deviation (s.d.) and range in parenthesis, was 11·8 (Ϯ3·9; [7][8][9][10][11][12][13][14][15][16][17][18][19], and for the children with transient or fluctuating values, 14·1 (Ϯ4·0; [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. At the time of the diagnosis of CD, children were of a mean age of 4·4 (Ϯ1·3; 3·1-6·7) years.…”

Section: Subjectsmentioning

confidence: 99%

Affinity maturation of immunoglobulin A anti-tissue transglutaminase autoantibodies during development of coeliac disease

Westerlund

Ankelo

Simell

et al. 2007

Clinical and Experimental Immunology

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SummaryCoeliac disease (CD) is an immune-mediated enteropathy triggered by ingestion of wheat gluten and related cereals in genetically predisposed individuals. Circulating immunoglobulin A (IgA) class autoantibodies against tissue transglutaminase (IgA-TGA) are highly specific and sensitive serological markers for CD, which is ultimately confirmed by duodenal biopsy. Although CD is considered a life-long disorder, transient or fluctuating IgA-TGA seropositivity has been observed in asymptomatic individuals on a glutencontaining diet. We set out to explore possible differences in the maturation of IgA-TGA avidity between individuals progressing to CD and subjects remaining healthy despite occasional expression of autoantibodies. We developed a time-resolved fluorometric IgA-TGA assay based on human recombinant tissue transglutaminase (tTG), and further modified the method to also measure urea-dependent avidity of the autoantibodies. We measured the autoantibody titres and avidities of sequential serum samples from 10 children developing CD and 10 children presenting transient or fluctuating autoantibodies. Both the initial titres at seroconversion and peak values of transient/fluctuating IgA-TGA were significantly lower than corresponding autoantibody titres in samples drawn from individuals with progressing CD (P = 0·004 and P = 0·0002, respectively). However, there were no statistically significant differences in the initial or peak avidity index values between the two groups of children. The avidity index values increased during the follow-up period (P = 0·013 for both groups) with no significant difference in the rate of avidity maturation between children with transient/fluctuating IgA-TGA and children developing CD. According to our results, high autoantibody titres have a higher predictive value than avidity maturation of TGA-IgA in screening for CD.

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Performance of Antibodies against Tissue Transglutaminase for the Diagnosis of Celiac Disease: Meta-Analysis

Cited by 51 publications

References 41 publications

Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children

Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children

Discrimination of exudative pleural effusions based on multiple biological parameters

Affinity maturation of immunoglobulin A anti-tissue transglutaminase autoantibodies during development of coeliac disease

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